Program Manager UM Regulatory Compliance (Fully Remote)

Dignity Health Management Services; United States; Remote; USD 100,000 - 140,000; Full time

Benefits offered by this job

Equipment provided

Job summary

Dignity Health Management Services is seeking an experienced audit professional to oversee delegated audits across UM, Credentialing, Claims, Enrollment, and Appeals, coordinating closely with Compliance.

The role requires deep knowledge of Knox-Keene, DMHC, and CMS rules and the ability to communicate policy changes to leadership. This fully remote position provides equipment and requires PST hours for cross-functional collaboration.

Qualifications

• Five years of experience in audits, policy review, and documentation.
• Bachelor's degree and working knowledge of Knox-Keene, DMHC, and CMS rules.
• Proven ability to communicate process changes and impact to leadership.

Responsibilities

• Oversee delegated audits related to UM, Credentialing, Claims, Enrollment, and Appeals in coordination with Compliance.
• Act as a subject matter expert on state and national regulatory bodies, aligning policies and workflows.
• Work with leadership on audit activities, corrective action plans, and contract delegation.

Skills

Audits

Policy review

Documentation

Communication to leadership

Education

Bachelor's degree

Job description

• Oversee delegated audits related to UM, Credentialing, Claims, Enrollment, and Appeals in coordination with Compliance.
• Act as a subject matter expert on state and national regulatory bodies, aligning policies and workflows.
• Work with leadership on audit activities, corrective action plans, and contract delegation.

Qualifications:

• Five years of experience in audits, policy review, and documentation.
• Bachelor's degree and working knowledge of Knox-Keen, DMHC, and CMS rules.
• Proven ability to communicate process changes and impact to leadership.
• This is a fully remote position with equipment provided (laptop, docking station, dual monitors).
• Must work PST business hours and collaborate with cross-functional teams.
• Opportunity to contribute to a mission-driven organization focused on quality care.

Dignity Health Management Services

Dignity Health Management Services offers integrated management and business services to healthcare providers, focusing on managed care administrative and clinical services to contain costs and improve quality. It is part of CommonSpirit Health, a large health system with a mission-driven culture centered on community and patient care.